Ajax Harwood Clinic

Testosterone testing: should I be tested?

Last reviewed 2026-09-23Content v25cc6652b3ab
Reference tool — not medical advice. Clinician judgement always required.

Low testosterone (male hypogonadism)

Defined testing criteria

Also called: low T, testosterone deficiency, male hypogonadism, andropause, low libido

Fatigue, low libido, mood change, or difficulty building muscle lead men to ask about 'low T,' often after seeing direct-to-consumer testosterone clinic advertising or an ND-ordered hormone panel. Some arrive already convinced testosterone replacement is the answer before testing has confirmed a deficiency.

Raises suspicion

  • • Decreased libido
  • • Erectile dysfunction
  • • Loss of morning erections
  • • Decreased muscle mass or strength, particularly alongside the sexual symptoms above
  • • Reduced energy specifically alongside sexual symptoms, not fatigue alone

Does not raise suspicion

  • • Fatigue, low mood, or poor concentration alone, without sexual symptoms
  • • A single afternoon or non-fasting testosterone level
  • • Age alone

Red flags

  • • Symptoms of a pituitary mass, such as visual field loss, headache, or other pituitary hormone deficiencies, alongside low testosterone: consider secondary hypogonadism and pituitary imaging
  • • Very low testosterone in a young man: consider a genetic or testicular cause and refer

Who to test

  • Men with symptoms and signs of testosterone deficiency: Testosterone (total, and free/bioavailable), men (Situation-specific)Morning (7-11 AM), fasting total testosterone as the initial test, confirmed by repeating it before diagnosis
  • Total testosterone near the lower limit of normal, or a condition known to alter SHBG such as obesity or diabetes: Testosterone (total, and free/bioavailable), men (Situation-specific)Add a free or calculated bioavailable testosterone
  • Confirmed testosterone deficiency: FSH (follicle-stimulating hormone) (Situation-specific)LH (covered in the FSH entry), to classify the deficiency as primary (high LH/FSH) or secondary (low or normal LH/FSH)

More likely instead

  • • Depression
  • • Sleep & insomnia (poor sleep lowers morning testosterone and libido)
  • • Sleep apnea (obstructive sleep apnea is associated with lower testosterone)
  • • Diabetes
  • • obesity or metabolic syndrome
  • • medication effects, such as opioids or some antidepressants
  • • Why am I tired? (for fatigue as the presenting complaint generally)

Counselling script

“If you have low libido, erectile dysfunction, loss of morning erections, or loss of muscle mass, alongside each other, a morning fasting testosterone level, repeated to confirm, is the right first test. Without those symptoms, fatigue alone doesn't point to low testosterone, and testing as a screen in asymptomatic men isn't recommended. If a low level is confirmed, we'll add FSH and LH to help find the cause before considering treatment.”

Chart snippet (OSCAR-safe plain text)

Concern discussed, not tested

Concern re: low testosterone discussed.
Discriminating features: decreased libido, erectile dysfunction, loss of morning erections, decreased muscle mass; absent.
Assessment: fatigue alone, low pre-test probability for testosterone deficiency.
Plan: no testosterone testing at this time.
Ref: Endocrine Society testosterone therapy guideline 2018; Canadian Urological Association testosterone deficiency guideline 2021.
Patient given info page: https://testosterone.ajaxharwoodclinic.com/patient
Revisit if: sexual symptoms or loss of muscle mass develop.

Testing ordered

Concern re: low testosterone discussed.
Discriminating features: decreased libido, erectile dysfunction, loss of morning erections, decreased muscle mass; some present as noted in chart.
Assessment: symptoms support testing for testosterone deficiency.
Plan: morning fasting total testosterone ordered, to be repeated to confirm before diagnosis; FSH and LH to follow if confirmed low.
Ref: Endocrine Society testosterone therapy guideline 2018; Canadian Urological Association testosterone deficiency guideline 2021.
Patient given info page: https://testosterone.ajaxharwoodclinic.com/patient
Revisit if: symptoms persist, or new pituitary symptoms such as headache or visual change develop.

Revisit if

  • • New or worsening sexual symptoms or loss of muscle mass
  • • Headache or visual field change, raising concern for a pituitary cause
  • • Symptoms persist despite confirmed normal testosterone: explore other causes

References

  1. 1. Endocrine Society. Testosterone Therapy in Men With Hypogonadism: An Endocrine Society Clinical Practice Guideline (2018)Diagnosis of hypogonadism should be made only in men with symptoms and signs consistent with deficiency and unequivocally and consistently low testosterone
  2. 2. Canadian Urological Association. Canadian Urological Association guideline on testosterone deficiency in men: Evidence-based Q&A (2021)Morning fasting total testosterone is the best initial screening test; LH classifies deficiency as primary or secondary
  3. 3. Canadian Urological Association / Choosing Wisely Canada. Urology recommendations (2025)Don't order serum testosterone in men without symptoms of hypogonadism
  4. 4. Canadian Society of Endocrinology and Metabolism / Choosing Wisely Canada. Endocrinology and Metabolism: Seven Tests and Treatments to Question (2026)Don't prescribe testosterone therapy without biochemical evidence of deficiency
Evidence notes

A women's section for this page (low libido or 'low testosterone' concerns in women) is intentionally not included here. The sex-hormones test batch found no validated female testosterone-deficiency threshold, and current assays are unreliable at female physiological levels. This is tracked as open question 8 in docs/open-questions.md, now drafted as the Low sex drive or 'low testosterone' in women section (Dr. Yu, 2026-09-23) on whether to add a women's section explaining why a blood level doesn't settle the question, or to leave it out. Tag rationale: A, not borderline. Male hypogonadism has well-defined symptom-plus-confirmed-biochemistry diagnostic criteria (Endocrine Society, Canadian Urological Association). Resolved 2026-09-23: Dr. Yu approved adding the women's section (decision 8).

Low sex drive or 'low testosterone' in women

Clinical diagnosis — no single test

Also called: low testosterone in women, female low T, low libido women, testosterone for women, hypoactive sexual desire disorder, HSDD

Women with low sex drive, low energy or low mood, often around perimenopause, ask whether low testosterone is the cause, sometimes after a saliva or blood hormone panel reported a 'low' level or after reading about testosterone for women online. The concern is real and common; the question is whether a blood level can answer it.

Raises suspicion

  • • A persistent loss of sexual desire that causes personal distress, especially after menopause, which is the pattern called hypoactive sexual desire disorder (HSDD) [1]
  • • Low desire that remains after other contributors (relationship factors, mood, medications, pain with sex, vaginal dryness, fatigue) have been looked at

Does not raise suspicion

  • • A 'low' testosterone result on its own, whether blood or saliva: blood assays are unreliable in the female range and a level does not diagnose HSDD [3, 2]
  • • Fatigue, low mood or weight change without a change in sexual desire
  • • Wanting testosterone for energy, wellbeing, muscle or bone: there is insufficient evidence for these uses [1]

Red flags

  • • Signs of too much androgen (new facial or body hair, acne, deepening voice, irregular periods), especially if rapid: this is a different question, worked up for androgen excess (see the Testosterone (total and free), women test page)
  • • Low desire with a low mood that is persistent or includes thoughts of self-harm: assess mood first

Who to test

  • Low sexual desire causing distressHSDD is a clinical diagnosis made after a full biopsychosocial assessment; a blood testosterone level should not be used to make it [2]. No routine hormone test is needed.
  • Signs of androgen excess, or suspected PCOS: Testosterone (total and free), women (Situation-specific), DHEA-S (dehydroepiandrosterone sulfate) (Situation-specific)This is the validated use of testosterone testing in women [4].
  • Starting testosterone therapy for diagnosed HSDD after menopause: Testosterone (total and free), women (Situation-specific)A baseline level and monitoring to keep levels in the premenopausal range, not to diagnose (Global Consensus 2019); specialist or experienced-prescriber input advised.

More likely instead

  • • Menopause (vaginal dryness, sleep disruption, hot flashes)
  • • Depression or anxiety
  • • relationship or life stressors
  • • medication effects (e.g. some antidepressants, hormonal contraception)
  • • pain with sex
  • • Sleep & insomnia or fatigue from another cause (see tired.)

Counselling script

“Low desire is real and worth addressing, but a testosterone blood test can't tell us whether hormones are the cause, because the tests aren't accurate at women's levels and guidelines say not to use a level for this. If low desire is distressing and persists once we've looked at mood, medications, relationship factors and vaginal symptoms, testosterone treatment after menopause is a reasonable option to discuss. It isn't recommended for energy, mood or weight.”

Chart snippet (OSCAR-safe plain text)

Concern discussed, not tested

Concern re: low testosterone / low sexual desire discussed.
Discriminating features: distressing low sexual desire; androgen excess features absent.
Assessment: testosterone level not diagnostic in women; HSDD is a clinical diagnosis after biopsychosocial assessment.
Plan: no testosterone level ordered; contributors reviewed (mood, medications, relationship, genitourinary symptoms).
Ref: Global Consensus Position Statement on Testosterone Therapy for Women 2019.
Patient given info page: https://testosterone.ajaxharwoodclinic.com/patient
Revisit if: distressing low desire persists after contributors addressed, or androgen excess features develop.

Testing ordered

Concern re: low sexual desire discussed.
Assessment: postmenopausal HSDD diagnosed clinically after biopsychosocial assessment.
Plan: baseline total testosterone ordered before considering therapy, for monitoring only, not diagnosis.
Ref: Global Consensus Position Statement on Testosterone Therapy for Women 2019.
Patient given info page: https://testosterone.ajaxharwoodclinic.com/patient
Revisit if: side effects or androgen excess features develop.

Revisit if

  • • Distressing low desire persists after contributing factors are addressed
  • • Signs of androgen excess develop

References

  1. 1. International Menopause Society et al. (Global Consensus). Global Consensus Position Statement on the Use of Testosterone Therapy for Women (2019)The only evidence-based indication for testosterone in women is HSDD; insufficient data for other symptoms
  2. 2. International Menopause Society et al. (Global Consensus). Global Consensus Position Statement on the Use of Testosterone Therapy for Women (2019)A blood total testosterone level should not be used to diagnose HSDD
  3. 3. International Menopause Society / Endocrine Society and other societies. Global Consensus Position Statement on the Use of Testosterone Therapy for Women (2019)Direct testosterone assays are highly unreliable in the female range
  4. 4. Endocrine Society. Evaluation and Treatment of Hirsutism in Premenopausal Women: An Endocrine Society Clinical Practice Guideline (2018)Androgen testing is indicated in the work-up of hirsutism
  5. 5. Endocrine Society. Androgen Therapy in Women: A Reappraisal: An Endocrine Society Clinical Practice Guideline (2014)— older guidelineEndocrine Society advises against diagnosing androgen deficiency in women or routine DHEA use
Evidence notes

Added 2026-09-23 at Dr. Yu's request (open question 8). Drafted by the senior reviewer directly from the verified Global Consensus 2019 full text and existing registry sources; no Sonnet stage. Tag B: HSDD is a real condition diagnosed clinically, with no test that settles it. 'Low testosterone' as a lab-defined female deficiency would be C, and is explained inside this section rather than tagged separately. The consensus notes no female testosterone product is approved by a national regulator; Canadian availability and dosing were not researched here (treatment is out of scope for a 'should I be tested?' page). Resolved 2026-09-23: approved with the rest of the content.

General clinical reference for Ajax Harwood Clinic. Not medical advice, and not a substitute for individualized clinical assessment.